Oncologic Applications of Photodynamic Therapy, Including Barrett Esophagus

This policy covers oncologic photodynamic therapy (PDT)—the use of a photosensitizer plus targeted light to ablate tumor tissue—for specified indications such as palliative treatment of obstructing esophageal cancer and endobronchial lesions, early‑stage non‑small‑cell lung cancer in patients ineligible for surgery/radiation, high‑grade dysplasia in Barrett esophagus, and palliative PDT for unresectable cholangiocarcinoma with biliary stenting, among other listed malignancies. PDT for malignancies not listed or for Barrett esophagus without high‑grade dysplasia is considered experimental/investigational; porfimer sodium causes photosensitivity requiring avoidance of bright light for 30 days, oral 5‑ALA is not FDA‑approved for PDT as of June 2025, and lesions amenable to Nd:YAG laser are not indicated for PDT.

"Palliative photodynamic therapy for obstructing esophageal cancer."